JP2003052736A - Thermotherapy apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a thermotherapy apparatus with which a fixed stable therapeutic effect can be provided regardless of the experience of doctor or individual difference of patient. SOLUTION: In the case of thermotherapy to a part to be treated by a microwave antenna 20, when the part is irradiated with laser beam emitted from an emission part 21a of an optical fiber 21 for laser beam irradiation, light scattered at the part where thermotherapy is carried out of the part to be treated is indirectly received by a light receiving part 22a of an optical fiber 22 for laser beam detection and on the basis of the intensity of the scattered light of the laser beam received by this light receiving part 22a, the degree of coagulation as a denatured state in the thermotherapeutic part of the target part is discriminated by a control part 36. In accordance with that degree, the irradiation of energy by the microwave antenna 20 is stopped.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a hyperthermia treatment apparatus for benign prostatic hyperplasia, for example.

[0002]

2. Description of the Related Art Generally, for example, Japanese Patent Laid-Open No. 7-95986 discloses a treatment device for treating benign prostatic hyperplasia.
Japanese Unexamined Patent Publication No. 7-95987 discloses a laser device for treating benign prostatic hyperplasia, which includes a laser balloon catheter for irradiating the prostate with a laser beam to perform thermotherapy.
The laser balloon catheter of this device is provided with a lumen tube surrounding the optical fiber, and a balloon is provided at the tip of this lumen tube.

When the laser balloon catheter is used, the laser balloon catheter is inserted into the urethra of a patient, and then cooling water is supplied to the balloon to inflate it at a position in the vicinity of the prostate, which is the tissue to be treated, to expand the balloon. It is designed to be fixed to the inner wall. In this state, laser light emitted from the tip of the optical fiber is applied to the prostate, which is the tissue to be treated, through the balloon to heat-treat the prostate and to circulate the cooling water in the balloon, thereby urinating the urethra. The living tissue in the inner wall portion is cooled, and protection against heat damage in that portion is added.

[0004]

In the above-described laser device for treating benign prostatic hyperplasia, the end of laser irradiation is left to the judgment of the doctor's experience or the setting of the device. Therefore, in the former case, due to the difference in the experience of doctors, there is a difference in the timing of the end of laser irradiation,
Treatment effects may vary. Further, in the latter case, there is a problem that the therapeutic effect varies depending on individual differences among patients.

The present invention has been made in view of the above circumstances, and an object thereof is to provide a heating treatment apparatus capable of obtaining a constant and stable treatment effect regardless of the experience of a doctor and individual differences of patients. To provide.

[0006]

According to a first aspect of the present invention, heating treatment means for heating and treating a target portion by applying energy for heating treatment to the target portion, and laser light for outputting laser light. An output part, and a light guide means for guiding the laser light output from the laser light output part to the target site side,
An emission part for irradiating the laser light guided by the light guide means toward the target region, and a scattered light in which the laser light emitted from the emission part is scattered by the warming treatment part of the target region. And a discriminating means for discriminating the denatured state of the warming treatment portion of the target site based on the intensity of scattered light of the laser light received by the light receiving portion. It is a heating treatment device. Further, according to the invention of claim 1, when the target region is irradiated with the laser light emitted from the emitting unit during the warming treatment of the target region by the warming treatment means, the warming treatment unit of the target region is irradiated. The degree of coagulation, which is the degenerative state of the warming treatment part of the target site, is determined by the discriminating means based on the intensity of the scattered light of the laser light received by this light receiving part Is determined, and the irradiation of energy by the heating treatment means is stopped accordingly. As a result, a constant therapeutic effect can be obtained without depending on the experience of doctors and individual differences of patients.

According to a second aspect of the present invention, the discriminating means grasps the degree of degeneration of the heating treatment section of the target region, and the degeneration state of the heating treatment section reaches a preset setting state. The warming treatment device according to claim 1, further comprising a warming treatment means stopping function of stopping the warming treatment means at a time point. In the invention of claim 2, the laser light emitted from the emitting unit is irradiated to the target portion during the heating treatment of the target portion, and the scattered light from the target portion undergoing the warming treatment is received by the light receiving portion. And the degree of coagulation of the target site is grasped by the discriminating means based on the intensity of the scattered light of the laser light received by the light receiving unit, and the coagulation state of the target site has reached the preset setting state. At this point, the heating treatment means stopping function of the discriminating means automatically stops the heating treatment means.

[0008]

BEST MODE FOR CARRYING OUT THE INVENTION A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 is a block diagram of the whole heating treatment apparatus 1 of this embodiment. The heating treatment device 1 of the present embodiment includes a main body device 2,
A urethral probe 3 which is a urethral applicator and a rectal probe 4 which are respectively connected to the main body device 2 are provided.

As shown in FIG. 2A, the urethral probe 3 has an elongated sheath-shaped shaft portion 5 as an insertion portion to be inserted into the urethra of a patient, and a proximal end side of the shaft portion 5. The body 6 of the hand-held operation portion connected to the end portion is provided.

Further, a cooling water inlet connector 7, a cooling water outlet connector 8, a balloon stopcock 9 communicating with a balloon 13 described later, a microwave connector 10 and a laser beam irradiation described later are provided on the body 6 of the hand-operated portion. An optical fiber connector 11 connected to the optical fiber 21 for use and an optical fiber connector 12 connected to the optical fiber 22 for laser light detection are provided respectively.

A balloon 13 which can be expanded and contracted is provided at the tip of the shaft portion 5. Then, by inflating the balloon 13 in a state where the shaft portion 5 is inserted and positioned in the urethra of the patient, the shaft portion 5 can be fixed at this positioning position.

In the sheath 5a of the shaft portion 5, a tubular cooling passage partition wall 14 is provided as shown in FIG. 2 (B). A microwave cable 15 is inserted through the axial center of the cooling path partition wall 14. Further, inside the sheath 5a of the shaft portion 5, two cooling water channels 16 and 17 inside and outside, which are partitioned by a cooling channel partition 14, are provided.
Here, an inner cooling water passage 16 inside the cooling passage partition wall 14,
The cooling water is set so as to circulate between the cooling water partition 17 and the outer cooling water passage 17 outside the cooling passage partition wall 14.

A spacer 18 is provided on the surface of the cooling passage partition wall 14. Further, a balloon lumen 19 is provided on the inner wall portion of the sheath 5 a of the shaft portion 5 so as to extend in the axial direction of the shaft portion 5. This balloon lumen 1
The distal end of 9 is connected to the balloon 13, and the proximal end is connected to the balloon stopcock 9 of the body 6 of the hand-operated portion. Then, through this balloon lumen 19, the balloon 13
And the balloon stopcock 9 are in communication with each other.

Further, as shown in FIG. 3 (A), a microwave antenna (warming treatment means) 20 is provided at the tip of the microwave cable 15. The microwave antenna 20 is located closer to the hand than the balloon 13.

On the inner wall of the sheath 5a of the shaft portion 5, a laser light irradiating optical fiber (light guiding means) 21 and a laser light detecting optical fiber 22 are arranged in a buried state. Here, the emitting portion 21a at the tip of the optical fiber 21 for irradiating the laser beam is arranged at a position closer to the balloon 13 than the balloon 13 and closer to the tip than the microwave antenna 20. Further, the light receiving portion 22a at the tip of the optical fiber 22 for laser light detection is located further on the hand side than the microwave antenna 20. The emitting portion 21a and the light receiving portion 22a at the tips of the optical fibers 21 and 22 are cut / polished at an angle of about 45 degrees with respect to the axial direction, as shown in FIG. Has been formed. As a result, the laser light that has entered the laser light irradiation optical fiber 21 in the direction of arrow A in FIG. 3B is reflected by this reflecting surface 23, and is emitted in a state of being bent 90 ° in the direction of arrow B. It is like this. The reflecting surface 23 is oriented so that the direction of the arrow B faces the surface direction of the shaft portion 5.

Here, the laser light incident in the opposite direction from the arrow B is reflected by the reflecting surface 23, is conducted through the laser light detecting optical fiber 22, and is irradiated in the direction of the arrow A. .

Further, as shown in FIG. 1, the main body device 2 of the heating treatment device 1 has a microwave output part 31, a laser light output part 32, and a laser light detection part 3 for generating microwaves.
3, a cooling water recirculation unit 34, a temperature measuring unit 35, a control unit (discriminating means) 36 for controlling them, a display / operation unit 37 for displaying / setting by the user, and a foot switch 38. Each is connected as shown.

Further, the microwave output section 31 is connected to the microwave cable 15 by the microwave connector 10 of the urethral probe 3 so as to supply the microwave to the microwave antenna 20. The laser light output unit 32 is connected to the laser light irradiation optical fiber 21 by the optical fiber connector 11 and supplies the laser light to the emission unit 21a. The laser light detector 33 is connected to the laser light detecting optical fiber 22 by the optical fiber connector 12 and receives the laser light incident on the light receiver 22a.

The cooling water recirculation part 34 is connected to the cooling water inlet connector 7 and the cooling water outlet connector 8 and communicates with the outer cooling water passage 17 and the inner cooling water passage 16 in the shaft portion 5 of the urethral probe 3, and the shaft. The cooling water is circulated and supplied to the section 5.

Further, the temperature measuring unit 35 is the rectal probe 4
Connected with. Then, the measurement signal is received from a temperature sensor (not shown) provided on the rectal probe 4.

Further, the control section 36 includes a laser beam detecting section 33.
The microwave output unit 31, the laser light output unit 32, and the cooling water recirculation unit 34 are controlled based on the output signal from the temperature measurement unit 35. Here, the control unit 36 grasps the degree of coagulation of the target site based on the output signal from the laser light detection unit 33, and when the coagulation state of the target site reaches a preset setting state, A microwave irradiation stop function for stopping the microwave output unit 31 is provided. It should be noted that the display / operation unit 37 is configured so that the microwave output value, the cooling water temperature, the set value of the flow rate, and the like are input by the operation of the operator and sent to the control unit 36. Further, the foot switch signal of the foot switch 38 is input to the control unit 36, and the ON / OFF operation of the microwave output unit 31 and the laser light output unit 32 is controlled by the control unit 36 according to the foot switch signal of the foot switch 38. It is like this.

Next, the operation of the heating treatment apparatus 1 of the present embodiment having the above configuration will be described. FIG. 4 shows a state in which the warming treatment apparatus 1 of the present embodiment is set in the patient H. In FIG. 4, H1 is the anus, H2 is the rectum, and H3.
Is the prostate, H4 and H5 are the rectal walls, H6 is the urethra, and H7 is the bladder.

Here, first, the shaft portion 5 of the urethral probe 3 is inserted into the urethra H6 of the living body so that the distal balloon 13 reaches the inside of the bladder H7. Then, a fixed amount of liquid or gas is injected from the balloon stopcock 9 to inflate the balloon 13. Then, after closing the balloon stopcock 9, the urethral probe 3 is positioned by bringing the balloon 13 into contact with the inner wall of the bladder H7 by gently pulling the urethral probe 3 toward the external urethra. At this time, the microwave antenna 20 is positioned so as to have a suitable positional relationship facing the prostate H3. Then, the rectal probe 4 is inserted into the rectum H2 through the anus H1.

Further, as shown in FIG. 4, after the urethral probe 3 and the rectal probe 4 are set, the heating treatment is started. FIG. 5 is a heating treatment apparatus 1 according to the present embodiment.
It is a flowchart which shows the effect | action at the time of the heating treatment.

At the start of this heating treatment, first, the foot switch 38 is turned on in the first step S1. During this operation, the microwave output unit 31 and the laser light output unit 32
And the cooling water recirculation unit 34 is turned on (step S
2). At this time, the microwave is applied to the microwave antenna 20.
Is released and the tissue portion of the prostate H3 is heated. At the same time, the cooling water flows into the cooling passage partition wall 1 inside the shaft portion 5.
4 and the outer cooling water passage 17 outside the cooling passage partition wall 14 to cool the urethral surface tissue of the prostate H3. During the warming treatment, the temperature of the rectal wall H5 is measured by the temperature measuring unit 35 by the output signal from the rectal probe 4.

Further, the laser light output by the ON operation of the laser light output unit 32 is irradiated from the emitting portion 21a of the laser light irradiation optical fiber 21 toward the lateral prostate tissue. This laser light is gradually absorbed inside the prostate tissue while being repeatedly scattered and reflected in a complicated manner as shown by an arrow in FIG. Then, a part of the laser light is incident on the light receiving portion 22a of the laser light detecting optical fiber 22 without being absorbed by the prostate tissue, and is detected by the laser light detecting portion 33 of the main body device 2.

Further, the scattering of laser light inside the prostate tissue changes depending on the water content, blood volume, etc. of the living body. That is, when the temperature inside the prostate increases and coagulation of the prostate tissue occurs, the water in that portion evaporates, and the scattering state of the laser light changes. Specifically, the scattering coefficient increases. Therefore, the intensity of the laser light detected by the laser light detector 33 increases.

Then, during the heating treatment, the control section 36 judges whether or not the intensity of the laser beam detected by the laser beam detecting section 33 exceeds a predetermined threshold value (step S3). When it is determined in step S3 that the intensity of the laser light does not exceed the predetermined threshold value, the process proceeds to the next step S4.

In step S4, it is judged whether or not the temperature of the rectal wall H5 measured by the temperature measuring unit 35 via the rectal probe 4 exceeds a predetermined threshold value.
When it is determined in step S4 that the temperature of the rectal wall H5 does not exceed the predetermined threshold value, the process proceeds to the next step S5.

In step S5, the foot switch 38
It is determined whether or not is turned off. When it is determined in step S5 that the foot switch 38 has not been turned off, the process returns to step S3.

Further, in step S3, the laser light detector 3
When the intensity of the laser beam detected in 3 exceeds a predetermined threshold value, the control unit 36 causes the microwave output unit 31 to
The laser light output unit 32 is stopped, and the microwave output and the laser light output are stopped regardless of the operation of the foot switch 38 (step S6). Further, if it is determined in step S4 that the temperature of the rectal wall H5 has exceeded a predetermined threshold value, or if it is determined in step S5 that the foot switch 38 has been turned off, the process similarly proceeds to step S6 and the microwave Output and laser light output are stopped.

Therefore, the warming treatment device 1 of the present embodiment having the above-mentioned configuration has the following effects. That is, in the hyperthermia treatment apparatus 1 of the present embodiment, microwaves are emitted from the microwave antenna 20 of the urethral probe 3 and the prostate H
By heating the tissue portion of No. 3, heating treatment of the tissue portion of the prostate H3 is performed. During the heating treatment of the target region, the laser light emitted from the emitting portion 21a at the tip of the optical fiber 21 for laser light irradiation is applied to the tissue portion of the prostate H3, and the prostate H3 coagulated during the heating treatment.
For detecting scattered light of the tissue part of the laser light 22
Is detected by the light receiving section 22a, and the control section 36 grasps the degree of coagulation of the tissue part of the prostate H3 based on the intensity of the laser beam received by the light receiving part 22a, and the coagulation state of the tissue part of the prostate H3 is preset. When it reaches the set state,
The laser light irradiation stop function of the control unit 36 automatically stops the laser light irradiation. Therefore, since unnecessary heating or insufficient heating can be prevented, there is an effect that a constant and stable therapeutic effect can be obtained irrespective of the doctor's experience and individual differences of patients.

Further, in the present embodiment, microwaves are used as an energy source for heating treatment, but laser beams or other energy such as high frequency may be used as an energy source for heating treatment.

Further, FIGS. 6A, 6B and 7
(A) and (B) show a second embodiment of the present invention. This embodiment is a laser that outputs a therapeutic laser beam instead of the microwave output unit 31 of the first embodiment (see FIGS. 1 to 5) as an energy source for heating treatment of the heating treatment apparatus 1. The light output unit 41 is provided.
Most of the other components have the same configuration as the heating treatment device 1 of the first embodiment, and the same parts as those of the heating treatment device 1 of the first embodiment are designated by the same reference numerals. Therefore, the description is omitted here.

That is, in the present embodiment, as shown in FIG. 6 (B), the body 6 of the urinary tract probe 3 near the operating portion is provided with a cooling water inlet connector 7 and a cooling water outlet, as in the first embodiment. Optical fiber connector 1 connected to connector 8, balloon stopcock 9 and laser light detection fiber 22
2, and an optical fiber connector 43 connected to a therapeutic laser optical fiber 42 described later.

In the sheath 5a of the shaft portion 5, a therapeutic laser optical fiber 42 is arranged at the axial center portion as shown in FIG. 7 (A). As shown in FIG. 7B, a scattering cap 44 formed by mixing a laser scatterer in a medium that transmits the laser light is provided at the tip of the therapeutic laser optical fiber 42. Then, all the laser light emitted from the tip of the therapeutic laser optical fiber 42 is applied to the scattering cap 44.

On the inner wall portion of the sheath 5a of the shaft portion 5, only the balloon lumen 19 and the laser light detecting optical fiber 22 are arranged. Here, the tip of the optical fiber 22 for laser light detection is polished at an angle of 45 degrees. The tip of the laser light detecting optical fiber 22 is located closer to the hand than the scattering cap 44.

In addition, the main body device 2 of the present embodiment has the first
As in the embodiment described above, a laser beam detector 33, a cooling water recirculation unit 34, a temperature measuring unit 35, a control unit 36, a display / operation unit 37, a foot switch 38 are provided, and energy for heating treatment is provided. A laser light output unit 41 for the therapeutic laser light used as a source is provided. The therapeutic laser light fiber 42 of the urethral probe 3 is connected to the laser light output unit 41.

Next, the operation of this embodiment having the above configuration will be described. In the heating treatment device 1 of the present embodiment, the first
Similar to the embodiment described above, the urethral probe 3 is inserted into the urethra H6 of the patient, and the positioning by the balloon 13 is performed. At this time, the scattering cap 44 of the therapeutic laser optical fiber 42 is positioned so as to have a suitable positional relationship facing the prostate H3.

After positioning the urethral probe 3, the foot switch 38 is turned on to start the heating treatment. At this time, the laser light output unit 41 and the cooling water recirculation unit 34 are turned on in synchronization with the ON operation of the foot switch 38.
Then, the laser light is supplied to the therapeutic laser optical fiber 42. Then, the laser light emitted from the tip of the therapeutic laser optical fiber 42 is scattered by the scattering cap 44 and is scattered and irradiated in the entire circumferential direction.

Further, the laser light is absorbed, scattered and reflected in the tissue of the prostate H3. At this time, the absorbed energy is converted into heat in the tissue of the prostate H3, and the prostate H3
The tissue part of is heated. In addition, a part of the laser light is repeatedly absorbed and reflected but is not absorbed by the tissue of the prostate H3.
The light enters the laser light 2a and is detected by the laser light detector 33 of the main body device 2. Since this detected value changes depending on the coagulation state of the tissue of the prostate H3, the laser light output unit 41 is stopped when the threshold value exceeds a predetermined threshold, and the output of the therapeutic laser light is stopped.

Therefore, in the heating treatment apparatus 1 of the present embodiment having the above-mentioned configuration, during the heating treatment, the laser light emitted from the distal end of the treatment laser optical fiber 42 is passed through the scattering cap 44 in the entire circumferential direction. Scattered to the prostate H
In the tissue of No. 3, the tissue part of the prostate H3 is heated by being converted into heat. Further, during the heating treatment of the target site, the scattered light of the tissue portion of the prostate H3 coagulated is detected by the light receiving portion 22a of the laser light detecting optical fiber 22, and the intensity of the laser light received by the light receiving portion 22a is detected. Based on the above, the control unit 36 grasps the degree of coagulation of the tissue portion of the prostate H3, and when the coagulation state of the tissue portion of the prostate H3 reaches a preset setting state, the laser light irradiation stop function of the control unit 36. With this, the irradiation of laser light is automatically stopped. Therefore, since unnecessary heating or insufficient heating can be prevented, there is an effect that a constant and stable therapeutic effect can be obtained irrespective of the doctor's experience and individual differences of patients.

Further, in the present embodiment, a laser light output for outputting a therapeutic laser beam instead of the microwave output section 31 of the first embodiment as an energy source for heating treatment of the heating treatment apparatus 1. Since the part 41 is provided, it is not necessary to provide a microwave output part in addition to the laser output part as in the first embodiment. Therefore, it is possible to reduce the size and cost of the device as compared with the first embodiment.

Further, in the present embodiment, the urethral probe 3
The optical fiber 21 for laser irradiation according to the first embodiment
Since it is not necessary to install the above, it is possible to reduce the diameter and the cost of the configuration of the urethral probe 3.

In addition, FIGS. 8A, 8B and 9
(A) and (B) show a third embodiment of the present invention. This embodiment is the second embodiment (see FIG. 6).
A puncture probe 51 for puncturing a prostate tissue is added to the urethral probe 3 of the hyperthermia treatment device 1 of FIGS. 7A and 7B and FIGS. 7A and 7B.

That is, the urethral probe 3 of the present embodiment
8B, the cooling water inlet connector 7, the cooling water outlet connector 8, the balloon stopcock 9, and the therapeutic laser are provided on the body 6 of the hand operation unit as in the second embodiment. Optical fiber connector 6 connected to the optical fiber 42
2 and a puncture probe base 52 for introducing the puncture probe 51.

Further, as shown in FIG. 9A, a puncture probe lumen 53 is provided on the inner wall of the shaft portion 5 of the urethral probe 3 so that the puncture probe 51 can be advanced and retracted. The proximal end of the puncture probe lumen 53 is connected to the puncture probe base 52. Further, a needle exit hole 54 is formed on the peripheral surface of the tip portion of the shaft portion 5 so as to open obliquely forward. The needle exit hole 54 is formed by the scattering cap 4 at the tip of the therapeutic laser optical fiber 42.
It is placed closer to the hand than 4. The needle exit hole 54 is connected to the tip of the puncture probe lumen 53.

The puncture probe 51 introduced from the puncture probe mouthpiece 52 into the puncture probe lumen 53 is guided to the needle exit hole 54 side through the puncture probe lumen 53, and protrudes from the needle exit hole 54 to the side of the shaft portion 5. It is designed to be deployed in a state of being extended diagonally forward.

Further, the puncture probe 51 is provided with a laser beam detecting optical fiber 55 and a sharp point 56 connected to the tip of the laser beam detecting optical fiber 55. The tip 56 of the puncture probe 51 is formed in a shape suitable for puncturing the prostate tissue. Further, a detection optical fiber 55 is provided at the rear end of the puncture probe 51.
There is provided an optical fiber connector 57 for connecting to.

Further, the laser light detecting portion 33 of the main body device 2 of the present embodiment is connected to the laser light detecting optical fiber 55 of the puncture probe 51 by the optical fiber connector 57 and receives the laser light incident from the tip 56. It is supposed to do. The rest of the configuration is similar to that of the second embodiment.

Next, the operation of this embodiment having the above configuration will be described. In the heating treatment device 1 of the present embodiment, the second
Similar to the embodiment described above, the urethral probe 3 is inserted into the urethra H6 of the patient, and the positioning by the balloon 13 is performed. At this time, the scattering cap 44 of the therapeutic laser optical fiber 42 is positioned so as to have a suitable positional relationship facing the prostate H3.

Thereafter, the puncture probe 51 is inserted from the puncture probe mouthpiece 52 of the urethral probe 3, protrudes from the needle exit hole 54, is expanded, and punctures the prostate tissue. In this state, the heating treatment is started by turning on the foot switch 38. At this time, when the foot switch 38 is turned on, the laser light output section 41 and the cooling water recirculation section 34 are turned on.
Is turned on and the laser light is the laser light fiber 42 for treatment.
Is supplied to. And the therapeutic laser optical fiber 42
The laser light emitted from the tip of is scattered by the scattering cap 44, is scattered and irradiated in the entire circumferential direction, and is irradiated to the prostate tissue.

Further, the laser light is absorbed, scattered and reflected in the tissue of the prostate H3. At this time, the absorbed energy is converted into heat in the tissue of the prostate H3, and the prostate H3
The tissue part of is heated. Further, a part of the laser light is repeatedly reflected and scattered, but is not absorbed by the tissue of the prostate H3, and is incident on the laser light detection optical fiber 55 of the puncture probe 51, and the laser light detection unit 33 of the main body device 2 is detected.
Detected at. Since the detected value changes depending on the coagulation state of the tissue of the prostate H3, the laser light output unit 41 is stopped when the threshold value exceeds a predetermined threshold, and the output of the therapeutic laser light is automatically stopped.

Therefore, in the heating treatment apparatus 1 of the present embodiment having the above-described configuration, the laser light emitted from the tip of the therapeutic laser optical fiber 42 is scattered by the scattering cap 44 as in the second embodiment. Scattering irradiation is performed in the entire circumferential direction via the irradiation, the heat is converted into heat in the tissue of the prostate H3 to heat the tissue part of the prostate H3, and at the time of coagulation being completed during the heating treatment of the target site, control is performed. Since the irradiation of the laser light is automatically stopped by the laser light irradiation stop function of the portion 36, it is possible to prevent unnecessary heating or insufficient heating. There is an effect that a constant and stable therapeutic effect can be obtained regardless of the difference.

Further, according to the present embodiment, since the puncture probe 51 for puncturing the prostate tissue is added to the urethral probe 3 of the second embodiment, the laser light detecting optical fiber 55 of this puncture probe 51 is added. The tip cusp 56 can be located approximately in the center of the heated prostate tissue. Therefore, in addition to the effect described in the urethral probe 3 of the second embodiment, there is an effect that the coagulation range can be detected with higher accuracy.

Further, FIGS. 10A, 10B and 11
(A) and (B) show a fourth embodiment of the present invention. In this embodiment, the configuration of the urethral probe 3 of the first embodiment (see FIGS. 1 to 5) is modified as follows.

That is, the urethral probe 3 of the present embodiment
As shown in FIG. 10 (A), a balloon stopcock 9, a puncture probe base 61, and
A scope base 62 is provided.

Further, a scope lumen 63 is provided at the axial center of the sheath 5a of the shaft portion 5 of the urethral probe 3. The base end portion of the scope lumen 63 is communicated with the scope base 62 of the body 6 of the hand operation unit.
And this scope lumen 63 has a scope base 6
The endoscope and the like can be inserted from 2 so as to be able to move forward and backward.

Further, as shown in FIG. 11A, the balloon lumen 19 is provided on the inner wall portion of the sheath 5a of the shaft portion 5.
A puncture probe lumen 64 and an optical fiber lumen 65 are provided. Here, the proximal end portion of the puncture probe lumen 64 is communicated with the puncture probe base 61 of the body 6 of the hand operation unit. Further, on the peripheral surface of the distal end portion of the shaft portion 5, a needle exit hole 66 arranged closer to the hand than the balloon 13 is formed so as to open obliquely forward. The needle exit hole 66 is formed by the puncture probe lumen 6
4 is connected to the tip portion.

A detection optical fiber 67 is inserted and laid in the optical fiber lumen 65. The tip of the detection optical fiber 67 is cut / polished at an angle of about 45 degrees with respect to the axial direction, and the reflecting surface 23 (see FIG.
(See (B)) is formed on the light receiving portion 67a. The light receiving portion 67a is arranged at a substantially intermediate position between the needle exit hole 66 and the balloon 13. Further, the base end portion of the detection optical fiber 67 is extended to the outside of the body 6 of the hand-side operation portion, and the extension end portion is provided with the optical fiber connector 68.

A puncture probe 69 is removably inserted inside the puncture probe lumen 64. A therapeutic laser optical fiber 70 is laid inside the puncture probe 69. At the tip of the optical fiber 70, a scattering cap 71 that receives and scatters laser light,
A sharp point 72 is provided which can preferably puncture the prostate tissue. Further, an optical fiber connector 73 connected to the therapeutic optical fiber 70 is provided at the rear end of the puncture probe 69.
Is provided.

The puncture probe 69 introduced from the puncture probe base 61 into the puncture probe lumen 64 is guided to the needle exit hole 66 side through the puncture probe lumen 64, and protrudes to the side of the shaft portion 5 from the needle exit hole 66. It is designed to be deployed in a state of being extended diagonally forward.

Next, the operation of the above configuration will be described.
In the warming treatment apparatus 1 of the present embodiment, as in the first embodiment, the urethral probe 3 is inserted into the urethra H6 of the patient, and the positioning by the balloon 13 is performed.

After that, the puncture probe 69 is inserted from the puncture probe mouthpiece 61 of the urethral probe 3, protrudes from the needle exit hole 66, expands, and punctures the prostate tissue. At this time,
The scattering cap 71 of the puncture probe 69 inserted into the prostate tissue is installed at a position facing the light receiving portion 67a of the detection optical fiber 67 provided on the surface of the urethral probe 3.

In this state, the heating treatment is started by turning on the foot switch 38. At this time, the laser light output unit 41 is turned on by the ON operation of the foot switch 38, and the laser light is supplied to the therapeutic laser optical fiber 70. Then, the laser light emitted from the distal end of the therapeutic laser optical fiber 70 is scattered by the scattering cap 71 and is applied to the prostate tissue.

Further, the laser light is absorbed / scattered / reflected in the tissue of the prostate H3. At this time, a part of the energy is absorbed by the prostate tissue to be converted into heat to heat the prostate. In addition, a part of the laser light is transmitted and enters the light receiving portion 67 a of the detection optical fiber 67, and is detected by the laser light detecting portion 42 of the main body device 2. Since this detected value changes depending on the coagulation state of the tissue of the prostate H3, the laser light output unit 41 is stopped when the coagulation is completed when the threshold value exceeds a predetermined threshold, and the output of the therapeutic laser light is automatically generated. Be stopped.

Therefore, in the above-mentioned structure, the laser light emitted from the tip of the therapeutic laser optical fiber 70 is scattered and irradiated through the scattering cap 71, and the prostate H
3 is converted into heat in the tissue to heat the tissue part of the prostate H3, and at the time of coagulation being completed during the heating treatment of the target site, the laser is stopped by the irradiation stop function of the laser light of the control part 36. Since the irradiation of light is automatically stopped, it is possible to prevent unnecessary heating or insufficient heating, and a constant and stable therapeutic effect regardless of the experience of doctors and individual differences of patients. There is an effect that can be obtained.

Further, according to this embodiment, the following effects are obtained in addition to the effects of the third embodiment. That is, since the puncture probe 69 is punctured into the prostate tissue and the laser light is emitted through the scattering cap 71 of the puncture probe 69 that is inserted into the prostate tissue, heating is performed from the inside of the prostate tissue. You can Therefore, cooling of the urethral surface is not required, and the urethral probe 3 and the main body device 2 are not required.
The structure is simplified, and the manufacturing cost can be reduced. Further, since the puncture can be performed under the endoscope, a safer puncture action can be performed.

Furthermore, the present invention is not limited to the above-mentioned embodiments, and it goes without saying that various modifications can be made without departing from the gist of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. Note (Additional Item 1) A light guide unit that guides laser light to be irradiated onto a target region, an emission unit that irradiates the laser light guided by the light guide unit toward the target region, and The degeneration state of the target region is determined based on the intensity of the laser light received by the light receiving unit and the light receiving unit that indirectly receives the laser light emitted from the emitting unit via the target region. A heating treatment device, comprising:

(Prior Art of Additional Item 1) The present invention relates to a laser device for treating benign prostatic hyperplasia. JP-A-7-959
86, JP-A-7-95987.

(Problem to be Solved by Supplementary Note 1) In the conventional laser apparatus for treating benign prostatic hyperplasia, the end of laser irradiation is left to the judgment of a doctor or the setting of the apparatus. Therefore, in the former case, there is a fear that an inexperienced doctor may make a mistake in the judgment, and in the latter case, there is a problem that the effect varies depending on individual differences among patients. The present invention has been made in view of these problems.

(Means for Solving the Problem of Appendix 1)
By irradiating the part to be solidified with laser light, detecting the scattered light and grasping the degree of solidification, the irradiation of energy is stopped accordingly. Therefore, it is possible to obtain a constant therapeutic effect irrespective of the doctor's experience and individual differences of patients.

(Effect of Additional Item 1) According to the present invention, the device detects the degenerated state of the tissue and automatically stops the output, so that unnecessary heating or insufficient heating can be prevented. There is an effect that a stable therapeutic effect can be obtained.

[0074]

According to the first aspect of the present invention, when the laser light emitted from the emitting portion is irradiated to the target portion during the heating treatment of the target portion by the heating treatment means, the target portion is heated. The light receiving section indirectly receives the scattered light scattered by the warming treatment section, and the discriminating means determines the degeneration state of the warming treatment section at the target site based on the intensity of the scattered light of the laser light received by the light receiving section. Since the degree of coagulation is determined and the irradiation of energy by the heating treatment means is stopped accordingly, unnecessary heating or insufficient heating is performed regardless of the doctor's experience and individual differences in patients. The temperature can be prevented. Therefore, there is an effect that a certain stable therapeutic effect can be obtained.

According to the second aspect of the present invention, the laser light emitted from the emitting portion is irradiated to the target portion during the heating treatment of the target portion, and the scattered light from the target portion undergoing the heat treatment is irradiated. The light receiving unit detects the degree of coagulation of the target site based on the intensity of the scattered light of the laser beam received by the light receiving unit, and the coagulation state of the target site is set to a preset setting state. When it reaches, the warming treatment means stop function of the discrimination means automatically stops the warming treatment means, so regardless of the experience of the doctor and individual differences of patients, unnecessary heating or insufficient heating Prevents warming. Therefore, there is an effect that a certain stable therapeutic effect can be obtained.

[Brief description of drawings]

FIG. 1 is a block diagram showing a schematic configuration of an entire heating treatment apparatus according to a first embodiment of the present invention.

FIG. 2 (A) is a plan view showing a urethral probe of the heating treatment device according to the first embodiment, and FIG. 2 (B) is 2B-2 of (A).
B line sectional drawing.

FIG. 3A is a vertical cross-sectional view of a main part showing an enlarged distal end portion of the shaft of the urethral probe according to the first embodiment;
FIG. 3B is a plan view showing the tip of the optical fiber.

FIG. 4 is an explanatory diagram for explaining a state in which the warming treatment device according to the first embodiment is set on a patient.

FIG. 5 is a flowchart for explaining the operation of the heating treatment device according to the first embodiment.

FIG. 6 shows a second embodiment of the present invention,
(A) is a block diagram showing a schematic configuration of the entire heating treatment apparatus, and (B) is a plan view showing a urethral probe of the heating treatment apparatus according to the second embodiment.

7A is a sectional view taken along line 7A-7A in FIG. 6B,
(B) is a longitudinal cross-sectional view of a main part showing an enlarged distal end of the shaft of the urethral probe according to the second embodiment.

FIG. 8 shows a third embodiment of the present invention,
(A) is a block diagram showing a schematic configuration of the entire heating treatment apparatus, and (B) is a plan view showing a urethral probe of the heating treatment apparatus according to the third embodiment.

9A is a sectional view taken along line 9A-9A in FIG. 8B,
(B) is a longitudinal cross-sectional view of a main part showing an enlarged distal end of the shaft of the urethral probe according to the third embodiment.

FIG. 10 shows a fourth embodiment of the present invention,
(A) is a block diagram showing a schematic configuration of the entire heating treatment device, and (B) is a plan view showing a urethral probe of the heating treatment device according to the fourth embodiment.

11A is a cross-sectional view taken along the line 11A-11A in FIG. 10B, and FIG. 11B is a vertical cross-sectional view of a main part showing an enlarged distal end portion of the shaft of the urethral probe according to the fourth embodiment. .

[Explanation of symbols]

20 Microwave antenna (heating treatment means) 21 Optical fiber for laser light irradiation (light guide means) 21a emission part 22 Optical fiber for laser light detection 22a Light receiving part 36 Control unit (discrimination means)

Claims (2)

[Claims] 1. A heating treatment means for applying heat treatment energy to a target site to heat the target site, a laser light output unit for outputting laser light, and a laser light output unit for outputting the laser light. Light guide means for guiding the generated laser light to the target site side, an emission section for irradiating the laser beam guided by the light guide section toward the target site, and an emission section for emitting the laser beam. A laser light receiving unit for receiving scattered light scattered by the heating treatment unit of the target region, and heating of the target region based on the intensity of the scattered light of the laser light received by the light receiving unit. A heating treatment device, comprising: a determination unit that determines a degenerated state of the treatment unit. 2. The determination means grasps the degree of degeneration of the heating treatment section of the target site, and when the degeneration state of the heating treatment section reaches a preset setting state, the heating unit The heating treatment apparatus according to claim 1, further comprising a heating treatment means stopping function for stopping the heating treatment means.